Launching the Levels of Exoskeleton Assistance—a clear, intuitive framework inspired by autonomous driving levels. This framework helps everyone—users, caregivers, therapists, researchers, and innovators alike—understand and track progress in exoskeleton development and automation
This is amazing. I built one to help my nephew walk, and now selling commercially ( http://trexorobotics.com )
I am fed-up at the lack of options available to individuals. People thought that everyone will get an exoskeleton and be able to walk with it everywhere. But the industry ran into many challenges.
A big one that many dont understand is getting insurance coverage. The way the US healthcare system is designed, it will only cover restoration of mobility, not a restoration of function. So, from their perspective, a wheelchair and some pain meds can do the job easily.
I believe that they key is to start with children, this is where you have families desperate for a solution, higher costs due to them growing and spending their entire life in a wheelchair, and the option to truly have a life changing impact.
But things are changing, people are starting to notice the work that we are doing. We need a lot more people building exoskeletons and similar powered orthotics!!
> So, from their perspective, a wheelchair and some pain meds can do the job easily.
And not even a good wheelchair. For my wife recently diagnosed with MS, they would only approve of a basic, featureless, uncomfortable one after I would pay the $3000 deductible plus 20% coinsurance. Instead, I got a light-weight folding electric wheelchair with nearly full-day worth of battery (15 miles), with a spare battery, adjustable headrest for $1300 off Amazon. Add an octopus-tripod fan with 10hr battery, golf-cart umbrella, bendable cane holder, bottle holder, and an A/C fan jacket for a total of $200 and now she is able to spend a few hours out with our kids at museums, aquariums, and zoos.
It was literally cheaper for me to buy all of this cash than try to spend 40+ hours getting insurance approval.
I absolutely love how practical and solid your product is. I cannot comment on the pricing because I have no idea what your costs/market is but if my kid needed $999/mo to walk, I would do literally anything to be able to afford it. Hopefully the costs keep coming down for those with a smaller budget. Good luck!
Great thing it works this way for mechanical tech.
For chemicals, that is, medicines, paying out of pocket is not impossible, but much harder. The $1500 you invested will likely last a number of years. Or it might be a month worth of prescription drugs; cheap generics do not exist for everything (and may sometimes be inferior).
I don't know a good way out of it. The U.S. medical insurance system sucks, but my friends from Germany and Netherlands report that theirs is even worse at providing any remotely advanced treatment.
> Germany and Netherlands report that theirs is even worse at providing any remotely advanced treatment.
It kind of depends on what you'd consider advanced treatment. I know a few people with chronic illnesses that are dependent on getting their (expensive) medications and they never had a problem with that. Besides the prescription fee of 5€ (not 100% sure on that one) they pay nothing out of their pocket.
But I've heard from people that that they often have problems for example with getting approval for new wheelchairs, accessibility adjustments for their cars, etc.
In general it is true that only necessities are covered by public health insurance. This makes sense in most cases for obvious reasons, but in some cases the limits seem totally arbitrary and are not beneficial to the consumer nor the insurer. Luckily I am young and healthy so my confrontations with our healthcare are limited to my bi-yearly dentist appointments, but I can absolutely imagine how there are gigantic bureaucratic hurdles when needing something remotely special.
Generally, getting a wheelchair or similar is a bit of a paper war with the insurance. Once you have it though, the barrier is lower to get a replacement or upgrades.
I’ve only managed to get more advanced treatment in the UK (still nothing ground breaking) by having private medical cover in addition to the national health care. Thankfully as the national health service covers all the basic care it’s possible to get private cover for around £40 per month.
That sounds _really_ good, and kind of blows a big hole in a lot of arguments against universal health care. I pay more than that monthly for relatively basic medication and that's _with_ pretty good employer-funded insurance
It gets better/worse. NHS provides universal cover for a lower per capita cost than Medicare/Medicaid covers the portion of the US population it covers.
Isn’t that a bit unfair of a comparison, since Medicare disproportionately covers the elderly who have higher medical costs, while the NHS serves the whole population?
The cost of Medicare + Medicaid divided by the number of people in the US - not the number of people covered by those services, has tended to be higher than the cost of the NHS divided by the number of people in the UK.
EDIT:
According to CMS[1], Medicare cost $799bn in 2019, and Medicaid cost $613bn in 2019. The Census bureau gave 328 million people in 2019 [3], or ~$4300 per person for Medicare and Medicaid whether or not they are covered.
According to Kings[2], the NHS cost 150bn pounds in 2019, or ~$208bn (I've not taking into account exchange rate changes). ONS gives mid-year estimate of 66.8m for the UK in 2019 [4].
Which gives $3113 for NHS per person, all of whom are covered.
The point is that if Medicare and Medicaid were allowed to work in the same kind of regulatory environment as the NHS (e.g. Medicare is legally prevented from negotiating best prices for some categories of cover), and was equally efficient, then you ought to be able to take the same budget and extend Medicare cover to every citizen of the US without paying more.
In fact, you'd have 33% more per resident to cover e.g. salary gaps without touching the Medicare/Medicaid budgets.
Americans are effectively paying twice, as money paid in private insurance is at least the same amount over again. It's bizarre to me there are no riots in the streets over this - current US healthcare regulation is corporate welfare to insurers and healthcare providers at the cost of regular people.
I called up the seller to buy more spare batteries and they said the 2 batteries the chair comes with, are under warranty for 1 year. And they should last another 2-3 years easily even with heavy use. So there's no point in buying spares now since the spares will lose the ability to charge over the same time.
We have been out for 2-3 hours per trip many times this year and not once has even one battery run out.
Talk about impactful work. I wonder how many lives you've changed.
Well done. This is something close to miracle tech, at least for the people wearing it.
I can't help but feel curious whether they're a viable alternative to wheelchairs, or if it's a temporary feeling (kind of like riding on a rollercoaster, in that you go and do it for the experience and then return to your normal life). But that's just my ignorance talking.
Also, fuck the US insurance system. You won't find many topics that make me talk that way, but as I get older it feels something closer to pure evil. I've met so many people who have been screwed over by that system (and personally experienced my share of it).
There's a woman I've been texting with who I met at a gas station. She was clearly in distress, so my wife and I offered her a ride home. To cut a long story short, she spent her fourth of july miserable, and when I raised the idea of getting prozac or some sort of antidepressant (my own "miracle tech"), she said "Oh, I used to be on that. I can't afford it because no insurance" and I practically flipped my phone onto the concrete. She could be living a normal and happy life.
I can't imagine how much worse it is for parents who otherwise need to spend $thousands for alternative solutions like this. If you can make it in any way affordable, it'll change countless lives, I'm certain.
I used to be on that. I can't afford it because no insurance
If/when anyone runs into this regarding medications, be aware that even without insurance many pharmacies (at least in chains) have significant lists of medications available at very little or no charge. Companies like GoodRX can also lead to much lower prices, particularly on generics.
Meijer has free antibiotics and prenatal vitamins.
Walmart has a variety of medications for many conditions at $4 for 30 days and $10 for 90, as well as inexpensive insulin options (discussed here on HN within the last month or two - maybe not preferred fastest-acting options, but certainly better than 'rationing hoping I don't die')
Walgreens has a prescription savings club for $20-35/year that has 30-90 day supplies of generics at various price points between $5-15 for 30-day supplies and 10-30 for 90 day supplies
CVS has some kind of system that I didn't create an account to look at but is likely similar.
Costco has a Member Prescription Program and has all their medication prices available on the site, and the pharmacy can be used for prescriptions even without a membership.
Kroger has a prescription savings club linked to GoodRX that has prescriptions at $0/3/6/9, with a membership of $36/72 year individual/family.
None of these plans are going to cover the medications being advertised on TV, but they're going to provide coverage for a lot of long-term proven generics that treat conditions that have been around as long as humans have. They may not be AS effective (or perhaps they just lack marketing budgets), but if they weren't at least SOMEWHAT effective they wouldn't still be around as generics.
And if you've read this far and are interested in other information on keeping medical care less expensive, I highly recommend looking up the Arm and a Leg Show podcast for a lot of useful information.
Some of the newer antidepressant manufacturers offer income-based coupons that cover the costs of the medications, as well.
Although Prozac has been generic forever, and depending where you live, you might be able to get a 30 day supply for a few bucks. Walmart has it for $4.
The expensive part is regularly seeing a doctor for prescription refills. Depending on the state and her income, she might be eligible for expanded Medicaid, though.
Expensive, but many families spend more on physio and other professionals (150$-300$ per hour). When we are talking about children's health and future, parents will raid their pensions accounts, grandparent's etc...
Hopefully once they get more popular, the government will pay for it to setup in Rehabilitation centers. From what I saw right now it's mostly private centers that are buying it (US/Canada).
New tech is always expensive at first. Selling something for $1k/month is better than not selling it at all. If these things were easy to make cheaply someone would be doing it.
It doesn't always need to be expensive, but it also isn't always inexpensive upfront. And the comment you reply to makes a plea about the price.
Price doesn't mean you haven't changed a lot of lives either: In addition, a lot of folks that can't walk are covered by some sort of government-provided insurance. Unfortunately, it doesn't really help all that much because insurance limitations don't always cover everything or cover enough.
I'll also say that it is a lot for a single person/family: It isn't nearly as much at a daycare, school, physical therapy and other such things. I'd not be surprised if such places weren't their most common home.
$1k a month seems downright cheap compared to many medical treatments.
Hospital visits in the US average $11.7k for a full stay[1]. Antiviral treatments for Hepatitis C like Harvoni and Sovaldi cost $16k-90k for 12 weeks, though you can go with a generic version for $5k-10k a month.
I was looking at the videos, and realized that maybe we don't need small exo-bones (societal expectations and normalcy aside), maybe it's easier to go the other way and make exo-robots, since they'd be bigger with more room for batteries, could balance on their own and a human could be sitting/standing inside, driving the legs with some input method - either with legs, or hand gestures.
I'm picturing the robot in Avatar [1], but with an open top and much less threatening and not weaponized [2], like big robotic pants. If I were to quit my job, it would be to make human robot minotaurs a reality, but then again, what do I know about robots?
I had thought when the Segway came out that a wheelchair version would follow shortly afterward where a person without functional legs could get on a saddle and move around quickly and at a typical human height so things on shelves aren't such a problem.
Segway hit the market 20 years ago and it still has not happened. I get that there are a number of complications (getting on and off is a challenge), but it seems like it should be solvable. The technology has only improved over the years, especially the batteries. This should be doable.
From my own (admittedly limited) experience with riding a Segway and my own (day to day) experience with a child that can't sit, stand or walk, I would guess that it is a) difficult to get in and out and b) difficult to balance and steer.
Extra mechanical stabilizers are in the way when you finally are on/in and without the Segway was really stubborn and threw me and others off in the beginning. A person without proper sense and ability to balance, will have big problems getting onto it and off again with just the gyros running. Also balancing is a really difficult thing to do if you have the problems that forced you in a wheelchair in the first place.
For people who are ok with the upper part of the body, and can lift themselves onto the machine, you might be right though. Unfortunately there doesn't seem to be a "used Segway" market that is cheap enough to attract hackers trying out new things with them.
Not long ago I saw a guy in a Segway-like wheel chair. It looked just like a regular wheelchair, with two wheels on each side. I spoke the owner and he loved it.
Here is a Segway converted to a wheelchair here in New Zealand:
A big issue for industry is medical certification too. Have you done yours? An exoskeleton like yours falls under Class II medical device and would require, at the minimum, a 510(k) notification to be filed.
That's too much getting in my face without giving me a chance to browse.
If I'm visiting the website, I'm probably going to be able to answer some of those questions without having these distracting offers thrown into my face immediately.
There are plenty of exoskeletons trainers for adults, Trexo novelty (well there is another device company in Sweden - Made For Movement ) is that they are targeting kids.
>The way the US healthcare system is designed, it will only cover restoration of mobility, not a restoration of function.
You'll find that countries with socialized medicine won't cover more than that either. It's too expensive, regardless of whether your covered privately or publicly. Socialized medicine is typically much harsher on keeping costs down as well.
I've always wondered about these devices. How do they work? Like they detect muscle contraction and amplify the motion? Or is it a purely mechanical device?
It looks expensive, and each machine is custom fitted to the users legs and also grows with the user. The market for it is really small to instantly lower the price.
Looks like an incredibly poor analysis by someone desperately holding onto their short position.
Tesla owners don't use the supercharger daily. The author's assessment that most people do, is simply invalid.
Based on my area and electricity costs (CAD $0.101/Kwh off-peak), the Model 3 costs 2.6 cents per mile (and not the 7 cents)
Also, the author takes in the upfront cost of the investment, to make the statement that it takes 20yrs to make your money back. However, he doesn't take into account the resale value of the same investemnt.
The base actuator is an off the shelf maxon, with our custom sensors and custom motor controller.
In terms of motion control, safety was the most important piece when designing our system. There are safety checks in the mechanical, electrical and the software sub system. There is a maximum force that the controller exerts on the child, which can be lowered or increased for each child. In addition to the child resisting, we also had to account for spasticity and sudden tone while walking. The controller detects high resistance and caps off the max force it sends to the motor.
That's a good point. Perhaps we can build a similar model to a car warranty where the actuators are covered for a longer period, but other components are not. Atleast it gives people a peace of mind regarding the most expensive items.
We have made significant progress towards lowering the price of our system, considering that similar devices up until now cost $75k-$150k. But it is still quite expensive for the vast majority.
Our price will continue to reduce over time, making it more accessible for both families and insurance.
This price is based on our current costs of producing and servicing these units at our projected quantities.
It is still quite expensive for most families, unfortunately.
Our goal is to engage with insurance companies to make this more affordable and accessible for the larger population, based on the early adopters that are buying and the clinical studies we are doing.
The thing that pisses me off is that there are so many startups or companies where insurance companies would benefit from providing service to product mappings much more smoothly and efficiently.
You should have to “think about wngaging with insurance companies”
There should be a fucking marketplace and a brokering system already in place that your products can be submitted to and that system gets you engaged with the insurance companies and thus your ultimate customers.
We are still producing at low quantities, but we have a pathway to bring down BOM costs with scale.
In terms of other applications, the technology that we are building can evolve for other uses over time, but its not a straight replacement. We wanted to target an immediate need that we saw in the world today.
Thanks! We have done some case studies where we have found improvements in walking. However, the primary case is that by using this device to walk at home everyday, kids can avoid many of the complications that may arise from sitting, i.e contractures, hip subluxation and other issues.
We will be conducting clinical studies to evaluate the effectiveness of our device in helping reduce some of these complications.
